Kelly Aicardi pulled open the garage-style door to a storage unit full of wheelchairs, walkers, beds and bedpans. The equipment-stuffed space is called the loan closet, and it’s what’s left of hospice care in Juneau. The city’s only provider of in-home and end-of-life care closed down in September.
“This used to be a lot more active when we had hospice patients,” Aicardi said. “Part of being in hospice is that we provide any equipment that is needed for the patient.”
She’s a volunteer coordinator for Catholic Community Services. The organization’s hospice and home health division closed because it couldn’t afford to keep nursing staff.
Now home and hospice patients are going without specialized care and even resorting to emergency room visits. It’s one of the consequences of a broader nursing shortage that’s affecting medical care across the state and shows no signs of slowing down.
The organization’s director, Erin Walker-Tolles, says she had long struggled to staff the program, but the pandemic made the market for nurses even tighter.
“There is a massive health care worker crisis happening in this country. And it’s especially challenging in Alaska,” she said.
Walker-Tolles says they were priced out as the need for traveling nurses increased dramatically and prices soared over the past few years.
“All across the country, the healthcare worker shortage is affecting especially nonprofit and smaller health care providers,” she said.
Bartlett Regional Hospital will take over hospice and home care, but there will be a wait. The hospital is also taking over the local nursing home for the same reason. But Juneau care providers aren’t the only ones struggling to maintain staff. Roughly a quarter of all nursing positions in Alaska are vacant.
Jared Kosin is the president and CEO of the Alaska Hospital and Healthcare Association, a trade group that represents hospitals and care centers. He says consolidations like the ones in Juneau are essentially closures, they just look different. He described a negative feedback loop that’s dogging the state’s healthcare providers.
“Once you’re short on workers and nurses, you’re essentially limited in your capacity and the services you can provide. And when you are providing less services, there’s less revenue coming in,” Kosin said.
Expenses are going up dramatically while the ability to collect revenue is going down. That’s leading to consolidations like the ones in Juneau, and closures in the Lower 48. Kosin says people get stuck in hospitals when smaller providers of what’s called “step-down care” — non-hospital environments like hospice and nursing homes — can’t stay afloat.
“If you can’t discharge out to the lower level of care, the system really grinds to a halt,” he said.
Kosin says the buildup of patients in the hospital is bad for the hospital’s bottom line. There’s no payment mechanism to support unnecessary stays in hospital beds. It’s an economic problem that’s created a social one.
“You still have all those people piling up to the hospitals,” he said. “They’re stuck in the most expensive environment of care in our healthcare system. And the real hard part with that is, not only is it the most expensive environment, they don’t need to be there.”
Back at the hospice loan closet, Kelly Aicardi was figuring out how to manage the non-medical services she can still provide.
“It’s been stressful for the employees, for sure,” Aicardi said. “But it’s way more devastating to the community as a whole.”
She says she’s been fielding phone calls from people whose parents are dying and need end of life care.
“They know that this is the only hospice. And then I have to tell them that we’ve suspended services, and then they’re like, ‘What can I do?’ And it’s really hard, because I don’t really have answers for them.”